Provider Demographics
NPI:1063826204
Name:SPARKS, LOWELL L JR (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:L
Last Name:SPARKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 HUNTER MOON WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2069
Mailing Address - Country:US
Mailing Address - Phone:951-845-6440
Mailing Address - Fax:951-755-7409
Practice Address - Street 1:1506 HUNTER MOON WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2069
Practice Address - Country:US
Practice Address - Phone:951-845-6440
Practice Address - Fax:951-755-7409
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA17687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine